Report Finds That Doctors Are Charging Medicare Patients at Higher Rates

A new study has found that over that the last decade thousands of doctors and other medical professionals have added more than $11 billion to fees for elderly patients on Medicare by using more expensive billing codes instead of cheaper ones.

The report “Cracking the Codes” from the non-profit investigative journalism organization Center on Public Integrity analyzed Medicare claims for a year and found thousands of providers engaging in the practice of “upcoding,” According to experts upcoding is the act of charging for more extensive and costly services than delivered.

The study found that 7,500 doctors charged the two most expensive paying codes for three out of four visits in 2008, up sharply from the number who did so at the beginning of the decade. The report says that medical groups argue that new technology and longer lifespans have made treating seniors more complex and time-consuming. According to the report there is little evidence that Medicare patients as a whole are older or sicker than in the past, or that the amount of time doctors spend treating them on average has risen.

Health care providers also claim that the rise in costs may be due to years of under-charging, and that the higher costs reflect more accurate billing, while Medicare regulators worry that the coding levels may be accelerating in part because of increased use of electronic health records. Electronic records make it easier to create detailed patient files with just a few mouse clicks, according to the report.

“This is an urgent problem,” Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, told the CPI. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t stand by and do nothing … that they are paying attention to this.”


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